Neuroleptic malignant syndrome | |
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Haloperidol, a known cause of NMS | |
Specialty | Critical care medicine, neurology, psychiatry |
Symptoms | High fever, confusion, rigid muscles, variable blood pressure, sweating[1] |
Complications | Rhabdomyolysis, high blood potassium, kidney failure, seizures[1][2] |
Usual onset | Within a few weeks or days[3] |
Causes | Antipsychotic medication[1] |
Risk factors | Dehydration, agitation, catatonia[4] |
Diagnostic method | Based on symptoms in someone who has started on antipsychotics within the last month[2] |
Differential diagnosis | Heat stroke, malignant hyperthermia, serotonin syndrome, lethal catatonia[2] |
Treatment | Stopping the offending medication, rapid cooling, starting other medications[2] |
Medication | Dantrolene, bromocriptine, diazepam[2] |
Prognosis | 10–15% risk of death[4] |
Frequency | 15 per 100,000 per year (on neuroleptics)[1] |
Neuroleptic malignant syndrome (NMS) is a rare[5][6] but life-threatening reaction that can occur in response to antipsychotic (neuroleptic) medications.[1] Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate.[1] Complications may include rhabdomyolysis, high blood potassium, kidney failure, or seizures.[1][2]
Any medications within the family of antipsychotics can cause the condition, though typical antipsychotics appear to have a higher risk than atypicals,[1] specifically first generation antipsychotics like haloperidol.[5] Onset is often within a few weeks of starting the medication but can occur at any time.[1][3] Risk factors include dehydration, agitation, and catatonia.[4]
Rapidly decreasing the use of levodopa or other dopamine agonists, such as pramipexole, may also trigger the condition.[1][7] The underlying mechanism involves blockage of dopamine receptors.[1] Diagnosis is based on symptoms.[2]
Management includes stopping the triggering medication, rapid cooling, and starting other medications.[2] Medications used include dantrolene, bromocriptine, and diazepam.[2] The risk of death among those affected is about 10%.[4] Rapid diagnosis and treatment is required to improve outcomes.[1] Many people can eventually be restarted on a lower dose of antipsychotic.[2][3]
As of 2011, among those in psychiatric hospitals on antipsychotics about 15 per 100,000 are affected per year (0.015%).[1] In the second half of the 20th century rates were over 100 times higher at about 2% (2,000 per 100,000).[1] Males appear to be more often affected than females.[1] The condition was first described in 1956.[1]
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